‘These are dangerous people’: How Russia is failing to treat soldiers with PTSD
Russian soldiers are returning from Ukraine with severe psychological disorders. The country’s health system is failing to treat them and some are going on to commit violent crimes.
By Sofya Volyanova.
Thousands of Russian soldiers are returning from the frontlines of Ukraine with mental health problems, including post-traumatic stress disorder (PTSD).
But in the three and a half years since the Kremlin launched its full-scale invasion, authorities have failed to create an effective system to give veterans psychological help.
Mental health practitioners told the BBC that many returning soldiers are reluctant to seek treatment, turning to drink instead. When they do accept support, the programmes are often insufficient and psychologists lack specialist training.
Given the notorious violence and cruelty within the ranks of the Russian army — and the fact that many of those serving in Ukraine are convicted criminals who agreed to fight for reduced sentences — the problem of how to reintegrate these men into society is acute.
Russia has already seen a spike in violent crimes at home since the start of the invasion, in part driven by ex-servicemen or those on leave, and experts say the trend is likely to grow worse.
Not one appointment
In the summer of 2023, a psychologist Yana* took a job at a new counselling centre in a hospital in a large Russian city (she asked that neither her real name nor that of the city be used).
The Russian Ministry of Health had opened such medical-psychological counselling offices across the country the same year, in order to treat those returning from the frontline. Civilians are also able to receive treatment in the centres, but military personnel and their families get priority.
Yana is against the invasion of Ukraine and believed that it would be hard for her to work with men who had fought there. But she decided her help could be useful.
“They are dangerous people, and I can make them less dangerous,” she told the BBC.
Her expertise, however, did not turn out to be in demand. In the 18 months that she has been at the centre, 17 military personnel have been referred to her by other therapists. Not one of them has ever showed up to an appointment.
It is hard to estimate the number of Russian soldiers who might need treatment for PTSD or other psychological disorders, but even the most conservative estimate puts their number in the tens of thousands.
Moscow has not said how many people are currently fighting, though in December 2023, Vladimir Putin announced that 617,000 soldiers were at the frontlines in Ukraine. A further 490,000 went the following year.
According to the Russian Bekhterev Centre of Psychiatry, between 3 and 11% of people who have seen action will suffer from PTSD. If a person has a serious injury, the likelihood of developing a disorder increases to 14-17%. Other experts have suggested that almost everyone returning from the frontline will show some signs of PTSD.
Since the start of the invasion, some 2,700 centres like the one where Yana works have been opened to offer psychological assistance and “reduce the stigmatisation of the psychiatric service”, though Yana said many such offices were small or understaffed.
The state-funded “Defenders of the Fatherland” programme also offers support, while volunteer networks aim to fill in the gaps.
The Ministry of Health did not respond to the BBC’s questions about how many returning soldiers had used the new medical centres. Defenders of the Fatherland provided psychological assistance to some 10,000 military personnel and their relatives between June 2023 and January of last year, according to the most recent figures.
‘Here I am good, but there I killed people’
The biggest problem is the reluctance of combatants to seek psychological help, mental health workers told the BBC.
“My colleague had a client who went into a cafe and started beating up the customers because they were sitting there relaxing.”
Despite the allocation of federal and regional funds, and promotion of psychological support through social media channels used by soldiers, military personnel believe they should deal with the problem themselves and that turning to therapy might impact their career.
“Most combatants don’t want to go to psychologists,” says Tatyana, who worked as a volunteer for the state-funded project “Family Hearth,” She asked the BBC not to use her last name.
“They have many excuses,” she says. “It’s either: ‘You wouldn’t understand. You weren’t there.’ Or: ‘You won’t be able to handle what I’m telling you… I’d rather go and have a drink with my friends, what’s there to talk about?’”
Tatyana says that men who have returned or are on leave from the front “develop an uncontrollable aggression” when they compare what they have seen and done in Ukraine to the relative ease of civilian life.
“My colleague had a client who went into a cafe and started beating up the customers because they were sitting there relaxing,” she says. “[There is] this internal conflict: here I am a good, kind person, and there I was killing people.”
Tatyana recalls working with one commander who, in order to maintain discipline, would put his subordinates in a pit and force them to sit for days without food or water. When he returned home to his family, he could not believe what he had done and asked himself: “Oh my God, how did I treat these children?”
“Family Hearth” planned ten sessions for each person who applied - in this short timeframe, specialists did not try to cure PTSD. The main priority was to return the person to a normal mental state: first of all, to teach him to communicate with people in a “peaceful environment”.
But over an entire year of work, only eight soldiers applied to Tatyana, of whom just two completed the course. Several broke down and started drinking.
“One even came to the session drunk,” she said. Another returned to the course after a two-week long binge. “For those who did not return, we simply assumed the same scenario.”
Low quality care
Even when soldiers do take up the offer of psychological support, the quality of care may be low.
In 2024, a study by researchers in St Petersburg attempted to take stock of the mental health support in Russia’s second city.
The results were not encouraging. Surveying psychologists working in 60 of St Petersburg’s 76 new psychological support offices, the researchers found that many lacked basic clinical experience.
Several had completed their training remotely, through short retraining courses offered by private institutions with little oversight. The authors of the study warned this could “lead to a decrease in the quality of care provided.”
They also uncovered inconsistencies in treatment. In the absence of unified protocols, psychologists were left to operate independently, drawing from a patchwork of approaches.
Of the more than 3,700 patients who were referred to a psychiatrist, just 20 followed through, and only 18 received treatment. The study did not report how many of these referrals were soldiers, and how many were family members or other civilians.
Another problem is that in an increasingly repressive climate — where criticism of what Russia calls a “special military operation” is illegal — both patients and practitioners are afraid to speak freely.
Psychologist Yana said: “We’re all afraid to talk. If you speak to someone who doesn’t share your views, it might get out. Someone might report you. And that’s it - your life is ruined.”
Yana recounted how clients would test her during sessions, dropping casual remarks about the war and closely watching her reaction.
Very few of her civilian clients, she said, openly support the war. Most simply want it to end.
Violence and addiction
In 2022, when Russia launched its full-scale invasion of Ukraine, it wasn’t just professional soldiers who were sent to the front.
By the summer of that year, prisoners were being actively recruited by the Wagner mercenary group, founded by the late Yevgeny Prigozhin.
In exchange for six months of service, they were promised clemency and full pardons. According to Prigozhin himself, some 50,000 inmates signed up.
By January 2024, Wagner’s role in recruitment had diminished and Russia’s Ministry of Defence had taken over. The conditions changed. Now, prisoners who volunteered to fight were required to serve for the duration of the war.
For most servicemen, whether convicted criminals or not, the terms of service are open-ended. Since the announcement of mass mobilisation in September 2022, military contracts have become effectively indefinite. Soldiers may only be discharged if they are seriously wounded, exceed the age limit, or are convicted of a new crime.
And that, increasingly, is happening.
According to an investigation by the independent media outlet Verstka, at least 242 people have died and 227 more have been injured in crimes committed by war veterans between February 2022 and August 2024. The cases range from murder to sexual assault and beatings.
In early 2025, criminologist Willie Maslov, of the Ural Law Institute under the Ministry of Internal Affairs, published a study examining the “impact of the special military operation on crime in Russia.”
His findings showed a marked increase in serious and particularly violent crimes across the country since the invasion began.
“Our patients don’t really want to be treated. They understand, perhaps, that something is wrong. But this problem is so terrible and traumatic and painful that they don’t want to touch it.”
Matvey*, a psychologist at a drug addiction clinic in one of Russia’s regions, said that he and his colleagues also expected to see a surge in PTSD-related alcohol abuse.
According to the Bekhterev Centre’s clinical guidelines, people who experience extreme trauma — like combat — are at high risk of substance abuse. In 2024, military personnel accounted for 10% of all those seeking addiction treatment at Russia’s flagship psychiatric hospital, the Serbsky Centre.
Despite the clear link, treatment options are limited — and often ineffective.
Matvey said that patients stay for a maximum of two weeks, meaning that they are offered “palliative care” rather than effective treatment for PTSD.
Methods like cognitive behaviour therapy, which have been shown to be effective in the treatment of PTSD, require at least 12 sessions.
For most, therapy is either too painful or too abstract to engage with, Matvey said. “Our patients don’t really want to be treated. They understand, perhaps, that something is wrong. But this problem is so terrible and traumatic and painful that they don’t want to touch it.”
He added: “I believe PTSD treatment should be more-or-less compulsory.”
President Putin himself proposed making therapy mandatory for returning soldiers in early 2024, but the suggestion has yet to be implemented.
Lack of professionals
One of the structural reasons for this failing is a shortage of qualified professionals.
Russian health minister Mikhail Murashko has acknowledged the problem, but estimates of the shortfall vary wildly. Depending on the source, the number of practicing psychologists in the country ranges from 57,000 to over 100,000.
According to the World Health Organisation, Russia has only 4 to 5 psychologists per 100,000 citizens compared with, for example, almost 30 in the United States.
In May of this year, Russia’s New People party proposed a national retraining programme for psychologists, citing the rise in military-related violent crime. Their proposal includes a registry of certified trauma specialists and an emphasis on practical training through the Ministry of Health.
Meanwhile, the state Duma is considering a bill that aims to regulate the entire profession.
Under its terms, psychologists without a degree in psychology must obtain one by 2030. They must also prove at least three years of clinical experience before opening a private practice. Supporters say the law will improve standards, though critics argue it will drive out professionals and worsen the shortage.
Nina Ostanina, chair of the Duma’s Committee on Family, Women and Children and one of the bill’s authors, rejected the criticism. “Charlatans [in the therapeutic professions], who outnumber stray dogs, will be cut off from the wounded and vulnerable… Isn’t three years enough time to help our heroes and get a proper education?”
Lawmakers are redrafting the proposals after the bill was rejected by the government.
‘Nobody understands how it works’
Despite difficulty in getting support to veterans, some psychologists say their work has not been in vain.
Yana continues to treat civilians, refugees, and families of soldiers, who are also suffering from PTSD and acute anxiety. In 10-12 sessions, she can often help her clients start to feel safe again, she said.
“It’s a good thing, because not many of them could [otherwise] afford psychological help.”
Tatyana, who volunteered for the “Family Hearth” project, said more needed to be done to reach combatants. “We do not have a single unified organisation throughout the country. People are forced to look for volunteers, to somehow cope on their own if they want to work with a psychologist.”
Yana agreed. “I still don’t understand how this is all supposed to work. Nobody does. Military personnel are here on leave. What am I supposed to do with two meetings?
“If this [creation of new psychological support centres] is preparation for when the war is over and everyone returns, then yes, that’s understandable. But what about now? They don’t even come when they do have the chance.”
*Names have been changed at the request of interviewees
Read the full story in Russian here.
Russian version edited by Olga Shamina.
Illustrations by Magerram Zeynalov/BBC
English version edited by Theo Merz.
Another stain on Putin’s “legacy”.